Prostate cancer is the most common noncutaneous cancer among males. Lung cancer and bronchial cancer account for 37% of male cancer deaths and prostate cancer and colon cancer account for another 10% each. The diagnosis and treatment of prostate cancer continue to create by mental act. With the development of prostate-specific antigen (PSA) screening more men are identified earlier as having prostate cancer. While prostate cancer can be a slow-growing cancer thousands of men die of the disease each year. Education is important to help men understand the assay of progression and the various treatment options. This article provides a current overview of the biology pathology diagnostic techniques natural history and screening for this disorder.
PSA is a single-chain glycoprotein that has chymotrypsinlike properties. PSA slowly hydrolyzes peptide bonds thereby liquifying semen. The upper limit of normal for PSA is 4 ng/mL. Some advocate age-related cutoffs such as 2.5 ng/mL for the fifth decade of life. 3.5 ng/mL for the sixth decade of life and 4.5 ng/mL for the seventh decade of life. Others advise race-specific compose ranges. Using recent data from screening studies some have advocated upper limits of normal of 2.5 ng/mL instead of 4 ng/mL.
A recent development the measurement of bound and free PSA can back up differentiate between patients with mildly elevated PSA levels from cancer and those with benign prostatic hyperplasia. The lower the ratio of free-to-total PSA the higher the likelihood of cancer. remove PSA is reported as a percent. Using 25% as the cutoff. 95% of cancers can be detected in both African Americans and whites. A cutoff of 22% maximizes cancer detection and minimizes unnecessary biopsies. Generally these percents are useful in patients who have a PSA aim in the range of 4-10 ng/mL.
This information is most useful in men with very large glands or in men who have already had one contradict biopsy result. If the man is healthy and has a PSA level of 4-10 ng/mL many recommend biopsy directly without the additional free-PSA test or consider a trial of antibiotic therapy for 4-6 weeks before repeating the PSA test. If antibiotic therapy lowers the PSA to normal levels in a bunco time prostate cancer is less likely to have caused the prior elevation and the PSA test should be repeated in a few months.
Various factors are taken into consideration when performing a DRE. A nodule is important but findings such as asymmetry difference in texture and bogginess are important clues to the patient's instruct and should be considered in conjunction with the PSA aim. Change in texture over time can offer important clues about the need for intervention. Cysts or stones cannot be accurately differentiated from cancer based on DRE findings alone; therefore maintain a high list of suspicion if the DRE results are abnormal. In addition if cancer is detected the DRE findings form the basis of clinical staging of the primary tumor (ie. T re-create in the TNM staging system). In current practice most patients diagnosed with prostate cancer undergo normal DRE results but abnormal PSA readings.
In the pre-PSA era patients with prostate cancer commonly presented with local symptoms. Urinary retention occurred in 20-25% approve or leg hurt occurred in 20-40% and hematuria occurred in 10-15%. Currently with PSA screening patients inform urinary frequency (38%) decreased urine be adrift (23%) urinary urgency (10%) and hematuria (1.4%). However none of these complaints is unique to prostate cancer and each could arise from a variety of other ailments. Forty-seven percent of patients are asymptomatic.
Metastatic symptoms include weight loss and loss of appetite; bone hurt with or without pathologic fracture (because prostate cancer when metastatic has a strong predilection for bone); and lower extremity pain and edema from nodal metastasis obstructing venous and lymphatic tributaries. Uremic symptoms can occur from ureteral obstruction caused by local prostate growth or retroperitoneal adenopathy secondary to nodal metastasis.
With the advent of PSA screening a greater number of men demand education about prostate cancer and how it is diagnosed staged and treated in order to select the most appropriate treatment.
According to recent figures from the American Cancer Society. 220,900 new cases were diagnosed in 2003 and 28,900 men will die of prostate cancer Prostate cancer is rarely diagnosed in men younger than 40 years and it is uncommon in men younger than 50 years.
Prevalence rates of prostate cancer be significantly higher in African American men than in color men while the prevalence in Hispanic men is similar to that of non-Hispanic color men. Hispanic men and African American men present with more advanced disease most likely related to external (eg income education insurance status) and cultural factors. In addition. African American men generally undergo higher levels of testosterone which may contribute to the higher incidence of carcinoma.
Between 1989 and 1992 incidence rates of prostate cancer increased dramatically probably because of earlier diagnoses in asymptomatic men as a result of the increased use of serum PSA testing. In fact the incidence of organ-confined disease at diagnosis has increased because both PSA testing and standard DRE are performed.
Prostate cancer incidence rates are currently declining with peak rates in 1992 among white men and in 1993 among African American men. Prostate cancer is also found during autopsies performed following other causes of death. The evaluate of this latent or autopsy cancer is much greater than that of clinical cancer. In fact it may be as high as 80% by age 80 years.
The prevalence of clinical cancer varies regionally and these differences may be due to some of the genetic hormonal and dietary factors discussed in the next section. High rates are reported in northern Europe and North America negociate rates are reported in southern Europe and Central and South America and low rates are reported in eastern Europe and Asia. Interestingly the prevalence of the latent or autopsy create of the disease is similar worldwide. Together with migration studies this suggests that environmental factors such as diet may play a significant promoting role in the development of a clinical cancer from a latent precursor.
) gene are on chromosome 1 while the human prostate cancer gene is on the X chromosome. In addition genetic studies suggest that a strong familial predisposition may be responsible for as many as 5-10% of prostate cancer cases. Recently several reports undergo suggested a shared familial risk (inherited or environmental) for prostate and breast cancer. Men with a family history of prostate cancer have a higher risk of developing prostate cancer and are also likely to show 6-7 years earlier.
African American men undergo a higher prevalence and more aggressive prostate cancer than color men who in move undergo a higher prevalence than men of Asian origin. Studies have open that young African American men have testosterone levels 15% higher than young white men. Furthermore evidence indicates that 5-alpha reductase may be more active in African Americans than in whites implying that hormonal differences may compete a role. The independent contribution of race alone is difficult to answer when the effects of health care access income education and insurance status are also considered.
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